Diagnosis and treatment of dynamic closed-mouth jaw locking in a dog

CASE DESCRIPTION: A 5-year-old neutered male English Bulldog was evaluated for intermittent closed-mouth jaw locking of approximately 1 week's duration. CLINICAL FINDINGS: Initial physical examination revealed a nonpainful inability to open the jaw with and without manual assistance; however, manipulation of the jaw after the dog was sedated for diagnostic imaging restored jaw function. Anesthesia was subsequently induced, and computed tomography was performed with the jaw open and closed; contrast agent-enhanced images of the closed jaw were also obtained. No abnormalities of the temporomandibular joints or retrobulbar space were detected. Fluoroscopic examination of movement of the temporomandibular joints revealed a dynamic interference of the rostrodorsal aspect of the coronoid process of the left mandibular ramus with the medial surface of the frontal process of the left zygomatic bone or the left orbital ligament. TREATMENT AND OUTCOME: Partial excision of the coronoid process of the left mandibular ramus was performed. The dog recovered without complication and was able to open and close its jaw and eat within 6 hours after surgery. No additional episodes of jaw locking were detected during the 6 months after surgery. CLINICAL RELEVANCE: To the authors' knowledge, closed-mouth jaw locking in animals attributable to dynamic interference of the rostrodorsal aspect of the coronoid process of a mandibular ramus with the medial surface of the frontal process of a zygomatic bone or an orbital ligament has not been described. Surgical excision of the coronoid process of the mandibular ramus appeared to provide a successful outcome in the dog of this report.     

Symphysiotomy, symphysiectomy, and intermandibular arthrodesis in a cat with open-mouth jaw locking--case report and literature review

A Persian cat was presented with open-mouth jaw locking. It was suspected that abnormal extrusion of the maxillary canine teeth caused contact with the mandibular canine teeth on closure of the mouth, resulting in levering forces that may have led to increased symphyseal mobility, temporomandibular joint laxity, rotational movement of the left mandibular body and locking of the left coronoid process lateral to the zygomatic arch. Symphysiotomy, symphysiectomy, circumferential and interdental wiring, and intraoral resin-based splint application were performed to achieve intermandibular arthrodesis. Following removal of all devices, no further jaw locking episodes were reported during a 33-month follow-up period.     

Excision arthroplasty as a treatment for temporomandibular dysplasia

Three cases of temporomandibular dysplasia are reported. Crepitus and pain were associated with manipulation of the lower jaw and in two cases there were episodes of open-mouth jaw-locking. Jaw-locking in these two cases was not associated with displacement of the coronoid process of the mandible and impingement on the zygomatic arch. Excision arthroplasty of the temporomandibular joint (mandibular condylectomy) was successful in preventing open-mouth jaw-locking and in curing temporomandibular joint pain.     

Intermittent open-mouth lower jaw locking in five dogs

Intermittent open-mouth lower jaw locking was documented in 5 dogs. In contrast to what has been reported in other cases, pronounced radiographic abnormalities in the temporomandibular joints were not observed. In 4 of the dogs, locking episodes started at a later age (35 to 83.5 months) than had been reported by others (6 to 22 months). Duration and frequency of locking were variable. Lateral shifting of the jaw and lack of neurologic deficits indicated a temporomandibular joint abnormality. Excision of the rostroventral portion of the involved zygomatic arch prevented locking in all cases. This syndrome involves variable severity of temporomandibular joint dysplasia, which could account for the variable age of onset and random frequency of locking episodes.     

Squamous cell carcinoma causing blindness and ophthalmoplegia in a cat

Ophthalmoplegia and blindness caused by squamous cell carcinoma were reported in a cat. Unilateral functional deficits of cranial nerves II, III, IV, and VI and of the sympathetic nerve supply caused blindness, complete ophthalmoplegia, and Horner syndrome. Radiography and computed tomography revealed a proliferating bony lesion associated with the right tympanic bulla, right temporal bone, right side of the mandible, and left frontal bone. A focal area of bony destruction involved the right sphenoid bone. The cat was euthanatized and necropsied. Squamous cell carcinoma was identified invading the bones and rostral part of the right side of the skull. The tumor had extended through the sphenoid bones into the region of the cavernous sinus and had surrounded the cranial nerves passing through this region. It also had invested connective tissue surrounding the optic nerves and had invaded the right globe through the lamina cribrosa. This represents an unusual distribution for ocular cranial squamous cell carcinoma in a cat.     

Facial swelling and discharging lesions associated with abnormalities of the mandible in kunekune pigs

Abstract

CASE HISTORIES: Four adult kunekune pigs developed facial swelling at the base of the right ear that ruptured and discharged food material. A further six pigs that had similar clinical signs were reported by members of the New Zealand Kunekune Association who responded to an email survey, one of which was confirmed by post-mortem examination.

CLINICAL FINDINGS: Inside the mouth of each pig there was an opening at the junction of the body and ramus of the mandible just lateral to the most caudal visible molar that was impacted with masticated feed. The food packed into the mandible resulted in infection and progressive erosion of the medullary cavity of the bone until it reached the ramus where it eroded through the lateral cortex. The feed material then tracked through the soft tissues to form a subcutaneous abscess, which eventually ruptured resulting in a draining lesion. In Case 2, which had had the lesion for 2 years, the cavity in the mandible was lined with mucosa that had healed to the skin to produce a fistula. In all four pigs there was also a lesion in the left side of the mandible that was not as developed as that on the right side.

DIAGNOSIS: The facial swellings were produced by feed material that had impacted into the mandible through an opening immediately caudal to the cheek teeth and then emerged through one or more lesions in the lateral aspect of the ramus of the mandible.

CLINICAL RELEVANCE: Although it has not been previously reported, anecdotal reports and our survey suggest that this condition may occur relatively frequently in kunekune pigs. It should be considered as a differential diagnosis for facial swellings and discharging lesions in these animals.     

Temporo-mandibular joint dysplasia and open-mouth jaw locking in a Bassett Hound: a case report

A case of temporo-mandibular joint dysplasia with open-mouth jaw locking is described with reference to diagnosis and surgical treatment. Previous cases reported in the literature are reviewed.     

Cerebral Blastomyces dermatitidis infection in a cat

CASE DESCRIPTION: An 8-year-old domestic shorthair cat was evaluated because of signs of depression, circling, and visual deficits. CLINICAL FINDINGS: The cat had no cutaneous lesions, and results of an ophthalmologic examination and thoracic radiography were within reference limits. Computed tomography of the brain revealed a mass lesion involving the right parietal, temporal, and occipital lobes; the mass was in broad-based contact with the skull and smoothly marginated and had strong homogenous enhancement after contrast agent administration. During craniectomy, samples of the mass were collected for cytologic and histopathologic evaluations and microbial culture. A diagnosis of Blastomyces dermatitidis-associated meningoencephalitis with secondary pyogranulomatous inflammation was made. TREATMENT AND OUTCOME: Amphotericin B (0.25 mg/kg [0.11 mg/lb], IV) was administered on alternate days (cumulative dose, 1.75 mg/kg [0.8 mg/lb]). To minimize the risk of nephrotoxicosis, assessments of serum biochemical variables (urea nitrogen and creatinine concentrations) and urinalyses were performed at intervals. The third dose of amphotericin B was postponed 48 hours because the cat became azotemic. The cat subsequently received fluconazole (10 mg/kg [4.5 mg/lb], PO, q 12 h) for 5.5 months. Six months after discontinuation of that treatment, the cat appeared healthy and had no signs of relapse. CLINICAL RELEVANCE: Brain infection with B dermatitidis is typically associated with widespread disseminated disease. The cat of this report had no evidence of systemic disease. Blastomycosis of the CNS should be considered as a differential diagnosis for brain lesions in cats from areas in which B dermatitidis is endemic.     

Multiple myeloma with central nervous system involvement in a cat

CASE DESCRIPTION: A 1.5-year-old spayed female domestic shorthair cat was admitted for hind limb locomotor difficulties and signs of pain along the lumbar portion of the vertebral column. At the time of referral, the cat was paraparetic with deficits in the spinal reflexes of the hind limbs. Neuroanatomic localization was at the L6-S2 spinal cord segments, corresponding approximately to the region of the L4-L6 vertebral bodies. CLINICAL FINDINGS: Radiography revealed a mixed osteolytic-proliferative lesion within the body of L5 involving the cranial end plate, as well as punctate radiolucencies in the distal portion of the femur. Magnetic resonance imaging revealed an intramedullary spinal cord lesion along with extensive meningeal and nerve root lesions in the area of the L4-L6 vertebral bodies. Cytologic analysis of a bone marrow aspirate from the right trochanteric fossa revealed a substantial plasma cell infiltrate. Analysis of CSF revealed a high protein concentration and morphologically abnormal plasma cells. Urine, but not serum, protein electrophoresis revealed a sharp gamma-globulin peak consistent with a monoclonal band of Bence-Jones proteins. The diagnosis was multiple myeloma. TREATMENT AND OUTCOME: The cat was treated with melphalan and prednisolone. A rapid clinical response was reported, and by week 3 after diagnosis, the cat's locomotion and behavior had normalized. However, by month 4, multifocal neurologic deficits were evident. The cat was euthanized at 9 months because of tetraparesis and substantial weight loss. CLINICAL RELEVANCE: To our knowledge, this is the first report of myeloma in a cat that had electrophoretically detectable light chain proteinuria but lacked a detectable serum monoclonal gammopathy.     

Diagnosis and treatment of arthrosis of cervical articular facet joints in Scottish Deerhounds: 9 cases (1998-2002)

OBJECTIVE: To determine diagnostic features and efficacy of treatment of arthrosis of the cervical articular facet joints between C2 and C3 in Scottish Deerhounds. DESIGN: Retrospective study. ANIMALS: 9 client-owned dogs. PROCEDURE: Medical records of affected dogs were reviewed. Diagnosis was confirmed by results of clinical examination (signs of severe pain from unilateral or bilateral flexion of the cervical vertebral column), radiography, myelography, and computed tomography. Treatment consisted of fluoroscopy-guided intra-articular injection of corticosteroids and lidocaine. RESULTS: Unilateral or bilateral arthrosis of the cervical facet joints between C2 and C3 was detected in all dogs. In 7 dogs, signs of pain were elicited by flexion of the side of the neck in which affected joints were detected radiographically. Two dogs had signs of pain during right lateral flexion, although bilateral lesions were detected. Five dogs had unilateral lesions, and 4 dogs had bilateral lesions; sclerosis and hypertrophy of the articular process were common. Two dogs had bridging of the articular space. Use of computed tomography confirmed the diagnosis. Myelography did not reveal abnormalities of the spinal cord or canal. After treatment, 8 dogs had rapid marked improvement of clinical signs, and 7 dogs remained free of clinical signs for > 4 months. CONCLUSIONS AND CLINICAL RELEVANCE: Arthrosis of the cervical facet joints in Scottish Deerhounds is a severely painful condition for which conventional radiography is a useful screening test. Intra-articular administration of corticosteroids and anesthetic is efficacious, long-lasting, and minimally invasive.     

Odontogenic cysts in three dogs: one odontogenic keratocyst and two dentigerous cysts

Odontogenic cysts, which showed cystic radiolucency in the jaw bone by radiographic examination and computed tomography, were enucleated by operation in 3 dogs. One dog had a odontogenic keratocyst in the incisive bone of the right maxilla and another 2 cases revealed dentigerous cysts in the mandible. These cyst walls were enucleated or transpired by semiconductor laser. Afterwards, osteogenesis was confirmed at the defective part of jaw bone by extirpation of the cyst in all cases, and no recurrence has been noted in any cases. Odontogenic cyst is a disease which should be treated by surgical extirpation or transpiration.     

Rapid prototyping and inclined plane technique in the treatment of maxillofacial malformations in a fox

An approximately 9-month-old fox (Pseudalopex vetulus) was presented with malocclusion and deviation of the lower jaw to the right side. Orthodontic treatment was performed using the inclined plane technique. Virtual 3D models and prototypes of the head were based on computed tomography (CT) image data to assist in diagnosis and treatment.     

Modified lateral orbitotomy for vision-sparing excision of a zygomatic mucocele in a dog

A 1-year-old Shar Pei presented for recent-onset exophthalmos and right peri-ocular facial swelling. Physical examination revealed the facial mass was of soft-tissue consistency and nonpainful to the dog. Due to inability to retropulse the globe during ophthalmologic examination, it was suspected the mass had impinged into the orbit, resulting in rostral displacement of the globe. Anatomic location suggested the lesion was probably associated with the zygomatic salivary gland. Fine-needle aspiration and subsequent cytological evaluation of fluid extracted from the facial mass was consistent with a diagnosis of zygomatic mucocele. Computed tomography imaging confirmed a single fluid-filled mass was resulting in both the facial distention and the exophthalmos. A modified, lateral orbitotomy surgical approach was selected for excision of the lesion to provide ventral exposure to the orbit, while minimizing trauma to the globe and supporting structures. Histopathology of the excised lesion confirmed a diagnosis of zygomatic mucocele. This case demonstrates utilization of a modified lateral orbitotomy for effective surgical management of a zygomatic mucocele in a dog, with preservation of vision and absence of any significant postoperative complications.     

Arthrocentesis of the temporomandibular joint in adult horses

OBJECTIVE: To develop a method for arthrocentesis of the temporomandibular joint in adult horses. ANIMALS: 7 equine cadaver heads and 6 clinically normal adult horses. PROCEDURE: Fluoroscopy, contrast radiography, and computed tomography were used on cadaver specimens to locate the temporomandibular joint, identify externally palpable landmarks for joint access, guide needle placement into the joint, and illustrate regional anatomy. The arthrocentesis technique was performed on 6 live healthy adult horses to determine efficacy and safety of this procedure. RESULTS: Externally palpable structures were identified as landmarks for temporomandibular arthrocentesis, including the lateral border of the condylar process of the mandible, the zygomatic process of the temporal bone, and the lateral pericapsular fat pad. Arthrocentesis was successful in all 6 joints in the live horses, and no complications developed. CONCLUSIONS AND CLINICAL RELEVANCE: The technique identified will improve the ability to examine and treat the temporomandibular joint in horses.     

Spontaneous external biliary fistula in a dog

CASE DESCRIPTION: A 10-year-old sexually intact female dog was examined because of a static, well-circumscribed subcutaneous mass and associated fistulous draining tract located along the right ventrolateral aspect of the thoracic body wall of 15 months' duration. CLINICAL FINDINGS: Results of computed tomography and fistulography confirmed the presence of the fistulous tract. Computed tomography also revealed a focal, hypodense region in the right ventral portion of the liver that was adjacent to but not clearly associated with the fistulous tract. TREATMENT AND OUTCOME: Surgical exploration of the tract revealed that it passed into the right hemithorax to the diaphragm; entered the right medial lobe of the liver; and terminated in a well-encapsulated, cystic liver lesion. The right medial liver lobe and all affected tissues were removed. Histologically, the liver lesion consisted of a fibrotic, dilated bile duct. The dilated bile duct and fistula were lined with biliary epithelium. On the basis of these findings, a diagnosis of spontaneous external biliary fistula was made. Five months after surgery, the dog was clinically normal. CLINICAL RELEVANCE: To the authors' knowledge, spontaneous external biliary fistula in a dog has not been reported in the veterinary medical literature. Despite the rarity of this condition, it should be considered in a dog with similar clinical findings. Clinical findings and results of appropriate diagnostic imaging procedures may provide valuable information in making this diagnosis and in planning surgical treatment.     

Temporomandibular joint dysplasia in an Irish Setter

Dysplasia of the temporomandibular joints was diagnosed in an Irish Setter. The condyloid process was mis-shapen and the glenoid fossa flattened, which allowed subluxation of the temporomandibular joints with recurrent locking of the coronoid process on the zygomatic arch with the mouth open. Permanent relief from open mouth jaw locking was given by partial zygomatic arch ostectomy.     

Radiographic, magnetic resonance imaging, computed tomographic, and rhinoscopic features of nasal aspergillosis in dogs

OBJECTIVE: To determine radiographic, magnetic resonance imaging (MRI), computed tomography (CT), and rhinoscopic features of nasal aspergillosis in dogs. DESIGN: Prospective study. ANIMALS: 15 client-owned dogs. PROCEDURE: All dogs had clinical signs of chronic nasal disease; the diagnosis of nasal aspergillosis was made on the basis of positive results for at least 2 diagnostic tests (serology, cytology, histology, or fungal culture) and detection of typical intrasinusal and intranasal fungal colonies and turbinate destruction via rhinoscopy. Radiography, MRI, and CT were performed under general anesthesia. Rhinoscopy was repeated to evaluate lesions and initiate treatment. Findings of radiography, MRI, CT, and rhinoscopy were compared. RESULTS: MRI and CT revealed lesions suggestive of nasal aspergillosis more frequently than did radiography. Computed tomography was the best technique for detection of cortical bone lesions; the nature of abnormal soft tissue, however, could not be identified. Magnetic resonance imaging allowed evaluation of lesions of the frontal bone and was especially useful for differentiating between a thickened mucosa and secretions or fungal colonies; however, fungal colonies could not be differentiated from secretions. Rhinoscopy allowed identification of the nature of intranasal and intrasinusal soft tissue but was not as useful as CT and MRI for defining the extent of lesions and provided no information regarding bone lesions. CONCLUSIONS AND CLINICAL RELEVANCE: The value of CT and MRI for diagnosis of nasal aspergillosis was similar and greater than that of radiography. Rhinoscopy is necessary because it is the only technique that allows direct visualization of fungal colonies.     

Virtopsy in a red kangaroo with oral osteomyelitis

This report describes the use of computed tomography (CT) in a nondomestic species. Postmortem CT was performed on a red kangaroo (Macropus rufus) and a diagnosis of oral osteomyelitis was made. CT examination revealed bony remodeling of the right mandible, an intraosseous lesion of the right temporal bone, muscle necrosis around the right mandible, and the absence of the right, first, upper molar tooth. Cardiac and intrahepatic gas and a distended intestine due to postmortem gas accumulation were also seen. All the lesions identified with CT were also identified by conventional necropsy, except the cardiac and intrahepatic gases. Virtopsy may be a useful procedure for the noninvasive identification of cause of death and as a guide for necropsy in animals.     

Migrating grass awn within the intraconal part of the retrobulbar space in a dog

A 1.5-year-old MC Cardigan Welsh Corgi was presented for a right oral fistula associated with left tonsil enlargement that responded to medical treatment. A first computed tomography scan was performed and showed no signs of a foreign body. Medical treatment was continued for 2 additional weeks and the dog was free of clinical signs for 3 months. The dog was presented again for a 3-day history of anorexia and marked pain when opening the jaw. The repeat computed tomography scan revealed a migrating foreign body near the optic canal of the right eye, and surgical exploration confirmed that it was trapped within the intraconal part of the retrobulbar space, abutting the optic nerve. The foreign body was surgically removed through an osteotomy of the zygomatic bone. The dog fully recovered with no vision loss. Based on the literature search, this is the first published report describing a migrating grass awn located in the intraconal part of the retrobulbar space, abutting the optic nerve.     

Assessment of ultrasonography and computed tomography for the evaluation of unilateral orbital disease in dogs

OBJECTIVE: To describe clinical, ultrasonographic, and computed tomographic (CT) features of confirmed neoplastic and nonneoplastic disease in dogs with unilateral orbital diseases, determine criteria to differentiate between the 2 conditions, and assess the relative value of ultrasonography and CT for the differential diagnosis of these 2 conditions. DESIGN: Prospective study. ANIMALS: 29 dogs with unilateral neoplastic orbital disease and 16 dogs with unilateral nonneoplastic orbital disease. PROCEDURES: Clinical history and results of physical and ophthalmologic examinations were recorded. Ultrasonographic and CT images were evaluated, and discriminating factors were identified to differentiate neoplastic from nonneoplastic diseases. Diagnostic value of ultrasonography and CT was assessed. RESULTS: Dogs with neoplastic disease were significantly older; had clinical signs for a longer time before initial examination; had more progressive onset of clinical signs; and more frequently had protrusion of the nictitating membrane, fever, and anorexia. The most discriminating factor for both imaging modalities was delineation of the margins (odds ratio was 41.7 for ultrasonography and 45 for CT), with neoplastic lesions clearly delineated more often. Ultrasonographically, neoplastic lesions were more frequently hypoechoic and homogeneous, with indentation of the globe and bone involvement evident more frequently than for nonneoplastic lesions. Mineralization was detected only with neoplasia. Fluctuant fluid was seen more frequently in dogs with nonneoplastic disease. Computed tomography more frequently revealed extraorbital involvement. Diagnostic value was similar for both imaging modalities. CONCLUSIONS AND CLINICAL RELEVANCE: Ultrasonography and CT are valuable imaging modalities to assist in differentiating neoplastic from nonneoplastic unilateral orbital disease in dogs.